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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal biopsies were carried out in 29 patients with scleroderma to study the early vascular lesions and their eventual clinical significance. Haemolytic acute renal failure was present in 9 patients. The biopsies showed early vascular lesions on interlobar arteries. The main biological change was proliferative or fibrous endarteritis. Mucoid infiltration was found in 3 biopsies. The arterioles were spared or only slightly affected without major fibrinoid necrosis. These lesions were therefore distinct from those of malignant hypertension. However, at autopsy of 2 of these cases, the vascular lesions were undistinguishable from those of malignant hypertension. The biopsies in 13 out of 14 patients with scleroderma without obvious renal involvement (9 cases) or with moderate proteinuria and/or hypertension without renal failure (5 cases) showed interlobar endarteritis with associated mucoid infiltration in 3 patients. This lesion was isolated but sometimes extensive even in young patients without hypertension. One patient died within one year, of disseminated colonic carcinoma, and 4 of cardio-respiratory failure due to scleroderma without hypertension, renal failure or proteinuria. Eight of the 9 remaining patients were traced 6 to 16 years after biopsy. Two were moderately hypertensive but none had renal failure. Cutaneous and internal organ scleroderma had regressed in the majority and proteinuria had disappeared in 3 cases.
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PMID:[Renal involvement in scleroderma]. 652 54

In a plant producing vinyl chloride by the emulsion method 200 workers who were exposed to vinyl chloride for 1 to 25 yr (mean 14), 58 (i.e. 29%) were free of complaints and nervous disturbances. An astheno-autonomic syndrome was found in 54 (i.e. 27%) and in 88 (i.e. 44%) in combination with positive neurological findings, i.e. pyramidal syndromes (in 52), cerebellar disturbances (in 38), trigeminal neuropathy (in 24) and extrapyramidal symptoms (in 3), in various combinations - pyramidal + cerebellar in 12, trigeminal + pyramidal in 7, trigeminal + cerebellar in 5. Headaches (48%), nervousness (26%), decrease in physical strength (16%), loss of memory (14%), sleeping disturbances and somnolence were the most frequent complaints. Scleroderma-like skin changes were found in ten subjects, but only six of them had any neurological disturbances. Occupational exposure to vinyl chloride was lower in workers without neurological findings. Frequency of the arterial hypertension was the same in both groups, whereas acroparesthesias, Raynaud's syndrome, and increased gamma GTP serum activity were significantly more frequent in workers with neurological disturbances. Sixty-two per cent of the neurologically positive group and only 24% of the negative group reported euphoric or narcotic states after exposure. This probably indicates episodic exposures to high concentrations of vinyl chloride. This difference points to a possibility that neurological disturbances may be related to short exposures to peak concentrations. The neurological injury may be both a direct neurotoxic effect of vinyl chloride and secondary to vascular disorders.
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PMID:Vinyl chloride disease-neurological disturbances. 662 5

A case of severe hypertension with secondary hyperaldosteronism developing in a 71 year old woman affected by "Crest" syndrome is reported. The patient was treated by nifedipine, which led to the correction of blood pressure, plasma renin activity and serum aldosterone. The role of renal arteries vasospasm and renin-angiotension system in the genesis of scleroderma is discussed.
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PMID:[Arterial hypertension with secondary hyperaldosteronism, reversible by nifedipine, in systemic scleroderma]. 666 13

Until recently acute renal failure in scleroderma has been uniformly fatal. Since 1973 there have been several reports of successful treatment by peritoneal and haemodialysis and nephrectomy, sometimes followed by renal transplantation. During the past few years there have been several reports of patients managed successfully with drug treatment. The present paper reports on a patient with scleroderma who is clinically well with stable renal function with drug treatment three years after the onset of acute renal impairment and hypertension. Other similar cases are reviewed.
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PMID:Medical treatment of hypertension and renal failure in scleroderma. 694 61

Since it has been suggested that the renin-angiotensin axis may play an important role in the severe hypertension and in the acute renal deterioration in scleroderma, we sought to determine the effectiveness of angiotensin blockade in the treatment of this disorder. Captopril controlled blood pressure successfully and easily in 4 consecutive patients with scleroderma renal crisis. Mean serum creatinine was 3.5 mg/dl after scleroderma renal crisis immediately prior to captopril. The first patient required maintenance hemodialysis because of progression to advanced renal failure before captopril was available. However, in this patient oliguric renal failure was changed to nonoliguric renal failure immediately after beginning therapy. Serum creatine stabilized in the other 3 patients. Serum creatinine peaked at 4.7 mg/dl, but then progressively improved to 3.5 mg/dl 12 weeks after captopril was begun. None of the other 3 patients required any form of dialysis during the scleroderma renal crises. Mean survival of these 4 patients was significantly greater than that of the 9 previous patients with scleroderma crisis. These observations confirm that angiotensin blockade with captopril is effective therapy to prevent renal deterioration, to control blood pressure and prolong survival in scleroderma patients with renal crisis.
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PMID:Clinical course of patients with scleroderma renal crisis treated with captopril. 702 35

The renal status of 38 patients with progressive systemic sclerosis (scleroderma) has been investigated by the usual clinical tests, urine electrophoresis, glomerular filtration rate (GFR) and renal plasma flow (RPF) determinations and in 4 cases by renal biopsy. Fourteen patients presented with proteinuria and/or a high serum creatinine and/or hypertension with low clearance values in all cases. In 14 other patients, an abnormality was apparent from clearance results (12 cases), renal biopsy (1), urine electrophoresis (1). The earliest sign of renal involvement that could be demonstrated was a reduced RPF and an elevated filtration fraction. Subsequently, a glomerular proteinuria with a electrophoretic pattern was observed as either the only sign (9 cases) or in association with abnormal clearance values (8 cases). The incidence of clinical renal involvement (proteinuria, renal failure, hypertension) ranged from 16 to 60%; 2/3 of patients who presented with proteinuria and hypertension died within 3 years. A mucoid thickening of intima and a fibrosis of adventitia in the proximal part of interlobar and arciform arteries, a fibrinoid necrosis in the distal part of lobular and preglomerular arteries are distinctive although inconstant features. The vascular lesions (seen in 70% of cases) and superimposed but reversible vasoconstriction, account for the decreased RPF. An effective control of blood pressure is mandatory; the therapeutic value of angiotensin converting enzyme inhibition remains to be corroborated.
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PMID:[The kidney in systemic scleroderma. A report of 38 consecutive cases ]. 712 5

A 53-year-old man with scleroderma, pulmonary fibrosis, cardiac decompensation and secondary polycythaemia, but no arterial hypertension, developed central retinal vein occlusion (CRVO) in the left eye. 1.5 years later, during the treatment with systemic steroids and anticoagulants, he developed CRVO in the right eye, and a further half year later, secondary glaucoma in the left eye and loss of the visual acuity to counting fingers at 2.5 m in the right eye and at 0.5 m in the left. Retinal vascular changes, pulmonary and cardiac insufficiency and secondary polycythemia, symptoms of scleroderma, most probably contributed to the development of bilateral CRVO.
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PMID:Bilateral central retinal vein occlusion in a patient with scleroderma. 726 1

There is no widely accepted treatment for the calcinosis which occurs in scleroderma and dermatomyositis. We report a case of a 62-yr-old woman with active scleroderma complicated by tuberose calcinosis. The calcinosis, which had previously been unchanged for several years, regressed over a 2-yr period during which diltiazem was used to treat hypertension. This effect could not be explained by altered disease activity or renal function but, we suggest, may be due to inhibition of calcium influx into cells. This treatment merits further evaluation.
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PMID:Diltiazem induces remission of calcinosis in scleroderma. 763 2

Microvascular involvement in scleroderma is well recognized. Macrovascular disease is not. OBJECTIVE. To test the hypothesis that the prevalence of macrovascular disease is increased in patients with limited scleroderma (systemic sclerosis, lSSc). METHODS. A retrospective cohort study design was employed in which the prevalence of macrovascular disease in all female patients from specified hospitals (1974-90) with lSSc of at least 5 years' duration was compared and contrasted with that in a comparable group of controls. Each control was matched to one lSSc case by sex; age (+/- 5 yrs); number of inpatient admissions (+/- 2); year of last hospital admission (+/- 2 yrs), history of hypertension, cigarette smoking and diabetes mellitus, and medical record number most closely approximating the case. The distribution of vascular disease was assessed in the peripheral, coronary, and cerebral arterial territories. RESULTS. Peripheral macrovascular disease (PVD) occurred in 18 (58%) of the lSSC patients and only 3 (9.6%) of the controls (RR = 6.0; 95% CI 2.0-18). Of the 18 lSSc cases, 8 had PVD documented angiographically, 4 by arterial Doppler ultrasound, and 6 had absent peripheral pulses. Five of these required subsequent partial limb amputation. Two of the 3 controls with PVD had absent peripheral pulses, and 1 had an angiographically documented abdominal aortic aneurysm. No control required limb amputation. There was no significant difference in the prevalence of coronary artery or cerebrovascular disease between the groups. CONCLUSION. The prevalence of peripheral large vessel occlusive disease is increased in lSSC and associated with severe morbidity.
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PMID:Limited scleroderma is associated with increased prevalence of macrovascular disease. 778 63

Physicians may be called upon to guide patients with renal disease on the advisability of conceiving or maintaining a gestation, or to manage pregnancies permitted to continue. The prevailing view is that the degree of functional impairment and the presence or absence of hypertension prior to conception determine both pregnancy outcome and the effect of gestation on the natural history of the kidney disorder (Table 3). Normotensive women with minimal dysfunction have a greater than 90% chance of success and there is little evidence that gestation will adversely affect the disease. Presence of hypertension increases the complications rate substantially if not aggressively controlled, and prognosis is also poorer in women with moderate renal dysfunction. Most gestations in the latter group succeed, but at considerable maternal risk: over 20% of these women experience renal functional deterioration, and 30-40% of them have major problems with hypertension. Thus we tend not to recommend pregnancy in patients with moderate renal insufficiency, and definitely discourage gestation when GFR is severely impaired. We advise termination, as most of these gestations fail, and maternal risk is substantial. There are a number of diseases in which pregnancy should not be undertaken, including scleroderma and periarteritis. Some authors believe that women with membranoproliferative glomerulonephritis also do poorly, and opinions differ on the effects of gestation on IgA nephropathy, focal glomerulosclerosis, and reflux nephropathy. Table 4 summarizes our view concerning pregnancy in a number of specific renal disorders. Finally, in addition to the controversies noted above, there are other unresolved problems requiring further study. For instance, protein restriction should be avoided until the effect of this therapeutic manoeuvre on fetal development is evaluated. Also needed are conclusive studies on whether or not the physiological hyperfiltration of human pregnancy affects adversely pre-existing renal disease.
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PMID:Gestation in women with kidney disease: prognosis and management. 792 14


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